P1305: NEPA VERSUS ONDANSETRON FOR THE PREVENTION OF CINV IN PATIENTS WITH MULTIPLE MYELOMA OR LYMPHOMA UNDERGOING HEMATOPOIETIC STEM CELL TRANSPLANTATION. A MONOCENTRIC REAL-LIFE EXPERIENCE.
Authors: Idanna Innocenti, Annamaria Tomasso, Antonio Mosca, Giulia Benintende, Michela Colalelli, Eugenio Galli, Patrizia Chiusolo, Elisabetta Metafuni, Sabrina Giammarco, Federica Sorà, Maria Assunta Limongiello, Alberto Fresa, Luca Stirparo, Fabio Lamberti, Francesco Autore, Andrea Bacigalupo, Stefan Hohaus, Valerio De Stefano, Simona Sica, Luca Laurenti
Journal: HemaSphere (2023)

Topic: 22. Stem cell transplantation - Clinical Background: Chemotherapy-induced nausea and vomiting (CINV) are adverse events that compromise quality of life and treatment compliance in patients undergoing autologous hematopoietic stem cell transplantation (ASCT). Polychemotherapy regimens, used as conditioning regimens for ASCT in lymphomas, and high-dose melphalan (≥140 mg/mq), used in multiple myeloma (MM) have high emetogenic risk. The three drugs currently used for antiemetic prophylaxis are serotonin (5-HT3) receptor antagonists as Ondansetron, NK1 receptor antagonists and dexamethasone. Netupitant-Palonosetron (NEPA), an oral formulation derived from the combination of Netupitant (NK1-RA) and Palonsetron, has been approved as prophylaxis of CINV but its experience is still limited. Aims: The primary aim was to compare the efficacy of Ondansetron and NEPA in terms of reduction of CINV in patients affected by lymphoma or MM undergone ASCT. The secondary aims included comparing the duration of CINV, based on the use of Ondansetron or NEPA, and their safety profile in terms of reduction of extrahaematological toxicity. Methods: In this retrospective monocentric study, we enrolled 76 patients (48 with MM and 28 with lymphoma), who underwent ASCT between March 2021 and March 2022, with a median age of 61 years. All patients with MM received high dose of melphalan, those with lymphoma received FEAM. Regarding antiemetics, patients who received NEPA were 33 with MM (one shot the day of conditioning) and 21 with lymphoma (every 72 hours during conditioning). Instead, 14 patients with MM and 8 with lymphoma received Ondansetron twice daily during conditioning. The Likert scale was used to measure the effectiveness of antiemetics. Results: Fifty patients (65%) reported CINV of any grade. In particular, the group experiencing CINV included about half of patients treated with NEPA (56%) and almost all those treated with Ondansetron (91%). Among the 26 patients who didn’t report CINV (35%), the majority received NEPA (92%) (P = 0.0032) (Figure 1a). Focusing on patients with MM, 59% of those treated with NEPA and 93% of those treated with Ondansetron reported CINV. Fifteen patients did not experience CINV (32%) and almost all (93%) had been treated with NEPA (P = 0.037) (Figure 1b). Sixty-one percent of the 28 patients with lymphoma reported CINV (P= 0.1914) (Figure 1c). Mean duration of CINV was significantly shorter for patients treated with NEPA than for those treated with Ondansetron (4.8 days vs 9.2 days) (P= 0.002) (Figure 1d). Regarding extraematological toxicity of chemotherapy, as mucositis and diarrhea, we didn’t find any significant difference between the two groups of patients. Regarding the outcome, 37% of patients had complete response to NEPA, 28% had controlled nausea and 31% had uncontrolled nausea, while only 5% of patients had complete response and 95% had uncontrolled nausea in the Ondansetron group (Figure 1e). According to CTCAE, 69% of patients receiving NEPA had grade 1 nausea and 6% had none, while 85% of patients receiving Ondansetron had grade 2 nausea and none had none. Summary/Conclusion: In our experience, NEPA has shown superiority in the prevention of CINV, in highly emetogenic regimens in both patients with myeloma or lymphoma, with advantages on the severity and the duration of CINV. Given the high burden of CINV in the whole population analyzed in the study, regardless of the antiemetic used, it would be useful to identify patients at greatest risk and standardize CINV prophylaxis and treatment protocols depending on the different chemotherapy regimens and their emetogenic risk.Keywords: Myeloma, Lymphoma, CINV prophylaxis, Autologous hematopoietic stem cell transplantation